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Rinse Water <br />Soap dispenser <br />Bleach and Water <br />Fire Extinguisher <br />Extra Ice Bags & Food Containers must be <br />stored 6 inches off of the ground/ <br />5 Gal Hand wash <br />Wastewater Container <br />Cutting Board <br />Ice Cooler <br />Propane Stove <br />Soap and Water <br />L_J I <br />I am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br />45°F (if food is used the following day, maintain below 41°F temperature): <br />El Ice chests L1 Refrigerator <br />0,1(efrigerated truck 0 Ice bath and tubs <br />0 Other (specify) <br />11. I am providing the following items within my booth for warewashing: <br />Et<ree compartment sink. <br />OR <br />0 Three deep tubs (basins 6-8 inches minimum), one for soapy water, one for rinsing and one for a bleach <br />solution (one tablespoon of bleach per gallon of water). <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensils: <br />t<tergent, bleach, wiping cloths (cleaning towels), and a tub to store wiping cloths in bleach solution. <br />13. I am providing the following for adequate hand washing facilities, but separate from utensil wash within my booth: <br />11<ater supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). A <br />separate tub (bucket or basin) for the collection of rinse/wastewater. Paper towels and a pump-style soap <br />container. <br />Names of responsible persons to be present in booth during all hours of operation: <br />"Do c-- rev <br />**Important** All food vendor booths are subject to inspection. Please make a copy of this application in <br />preparation for this event. A copy of this checklist must be in the booth at all hours of <br />preparation and operation. Return oridinal to festival coordinator three weeks prior to <br />this event. <br />Completed by: virbdeci.x.0-b,c <br />Signature Title <br /> <br />Garbage <br />Can <br />Health Permit <br />Sterno wIChaffing <br />Dish <br />5-20 Gal <br />Hand wash Water <br />Paper Hand Towels <br />Sanitizer bucket- <br />bleach & water for <br />storing wiping cloths <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp <br />EHD 16-02 Page 8 01 11 TEMP EVENT APP <br />7/14/15